Research: Accountable Care Organizations and Health IT

Andrew Principe04/02/12

Accountable Care Organization Shared Savings Program

The ongoing healthcare data revolution continues to change the way payers and providers leverage health data to improve clinical outcomes and reduce costs. As providers take the early steps at driving toward an integrated data ecosystem, several factors are accelerating and justifying the need for them to invest in a strong IT infrastructure.

The Centers for Medicare and Medicaid Services has become one of these accelerating factors by deploying the CMS Accountable Care Organization Shared Savings Program. This payment model supports providers who want to adopt new models of care in harmony with a robust base of health IT, while allowing them to hedge their risk in the early stages to allow for investment.

The CMS ACO Shared Savings Program relies heavily on accurate, timely and actionable clinical data that drives advanced analytics that measure not only the quality of care but also its cost. This level of analytics requires seamless coordination among care providers and accurate attribution models. (Attribution models assign patients to providers to properly align accountability for care management and associated incentives when that provider demonstrates performance against standards.) Care coordination isn't possible without a comprehensive governing body that supports and enforces the pillars of change the model brings.

The investment and infrastructure needed to succeed under such a payment model cannot be set up overnight but nonetheless requires a degree of urgency. The low-risk nature of the Shared Savings Program allows ACOs to develop and mature in a reimbursement environment that rewards results, while allowing providers to learn from mistakes and pitfalls in the same environment. Such an arrangement means missteps will not necessarily mark the end of an experiment.

This report addresses the issues healthcare providers face as they enter this brave new world and explains how the CMS Shared Savings Program builds on other health IT initiatives--including Meaningful Use--and helps providers understand the common pitfalls and missteps they face in leveraging health IT. Most importantly, the report will help your organization move forward and plan for success under such a payment model. (R4870512)